中度或严重免疫受损的人应获得第三剂辉瑞-biontech或Moderna mRNA疫苗，即Centers for Disease Control and Prevention (CDC) recommendedin August 2021.
This group, which includes people on medications commonly used forrheumatic diseases如rheumatoid arthritis (RA)and银屑病关节炎（PSA），仍然容易签约COVID-19该机构说，即使他们有两枪。
The third inoculation does make a difference.Researchers reported at the annual conference of the American College of Rheumatology (ACR) in November 2021that people on the common drug利妥昔单抗who did not develop antibodies against COVID-19 after the first two doses were able to do so after the additional shot.
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To help people understand what this means for those with these diseases, theACR更新了其临床指南，以描述这种额外剂量的重要性。
患有RA的人have many questions about the COVID-19 vaccine，尤其是关于这种新添加的剂量。为了获得常见问题的答案，我们与之交谈Juan J. Maya-Villamizar, MD，，，，arheumatologistat the Rheumatology Center of Palm Beach, in Lake Worth, Florida, and a medical adviser to the digital arthritis community吱吱作响。
bob体育在线日常健康: Does the CDC’s recommendation that people who are immunocompromised get a third shot of their mRNA vaccines apply to everyone with rheumatoid arthritis?
Juan Maya-Villamizar博士：人们并不是人们患有像RA这样的自身免疫性状况，而是问题，而是这些疾病的人通常服用免疫抑制药物。对第三次射击的需求涵盖了我们用于RA的大多数药物的人员，除了药物外hydroxychloroquine。
Some medications that trigger the need for a third dose include steroids, tumor necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6), methotrexate,磺胺嗪，，，，leflunomide，，，，硫唑嘌呤，，，，mycophenolate, and Janus kinase (JAK) inhibitors. People who are not on immunosuppressive drugs because they have low disease activity or who are only on hydroxychloroquine are not part of this group.
EH：为什么使用这些药物的人会从第三张镜头中受益？
JMV:数据显示的是，在第二剂剂量之后通常不会生成针对COVID-19的抗体。在某些研究中，多达50％的接受免疫抑制药物的患者没有产生抗体。通过获得第三次剂量，最终开发抗体的人数增加了。即使这样，并不是每个人都会做到。
EH: When should a person get the third dose?
JMV:建议是在辉瑞或现代疫苗的第二次射击后至少四个星期拍摄。如果可能的话，您应该坚持以前的相同。因此，如果您的前两次镜头有Moderna，则应尝试将其三分之一。CDC单词“如果可能”的含义是，如果您由于某种原因无法获得相同的疫苗，您可以得到另一个mRNA疫苗。
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So far there is no official recommendation about another shot for immunocompromised people who initially got the Johnson & Johnson vaccine, but we expect that to be coming.
[[The CDC has issued a general recommendation在两个月或更长时间后，每个人都有18岁以上的J＆J拍摄的疫苗的助推器。]
EH：获得额外射击的风险吗？
JMV:对于免疫功能低下的患者，除了预期的任何疫苗的反应外，没有任何风险：局部化arm pain或反应，或像肌肉酸痛，发烧或发冷一样感冒的症状。如果您对先前的镜头有反应，这并不意味着您将在第三张镜头后有一张，但这是可能的。
患有RA的人也可能会有些关节疼痛。建议是使用您的典型药物，例如对乙酰氨基酚，，，，布洛芬， 或者阿莱夫。如果您觉得自己有严重的关节疼痛反应，请务必与风湿病学家交谈。
当然，在任何类型的干预措施下，总是有很小一部分意外反应。如果您获得第三次镜头后会出现与您有关的事情，请与您的医生交谈。
EH: The American College of Rheumatology recommends that people briefly改变他们的某些药物的时间when they get the first or second shot if their disease is stable. For example, they suggest that JAK inhibitors should be delayed for a week after each COVID-19 vaccine dose. Do these same recommendations apply for the third shot, too?
JMV:工作组要同意,某些药物d again be held for one to two weeks around the vaccine, such as mycophenolate and JAK inhibitors. But they did not reach consensus about shifting medications around the third shot for many medicines, including steroids and most biologics. I myself am telling my patients whose disease is stable to follow the same recommendations as for the other shots, since this may help improve response to the vaccine. Everyone should talk to their doctor about their own treatment situation.
EH：是否还有其他患有风湿病的人应该知道疫苗？
JMV:毫无疑问，每个人都应该接种疫苗。最近的数据表明，Covid-19的大多数医院入院都在未接种疫苗的患者中。显然，接种疫苗会降低您入院的风险，并阻止您获得更强的疾病形式。由于居住在那里的所有其他感染，因此留在医院中对免疫功能低下的人有额外的好处。
如果您有具体的担忧使您无法接种疫苗，请务必与您的医生分享。
即使在获得三枪之后，对于那些被免疫功能低下的人来说仍然很重要，以便在疾病扩散时努力遵循其他Covid-19预防措施，例如戴口罩；避免大型聚会，尤其是在通风不良的空间中；并保持至少六英尺的距离其他人。
